At-risk personality types in advanced cancer care: Does pessimism and trait anxiety predict patients’ chemotherapy side-effect expectations and do patients benefit from empathy or nocebo information?: Findings from a scripted video-vignette RCT.

Background: To alleviate side-effect burden in advanced breast cancer, it is necessary to identify at-risk personality types and effective interventions. Previous research indicates that patients’ pessimism and trait anxiety may be risk factors for experiencing side-effects. To reduce their side-effect burden, optimizing patients’ side-effect expectations is suggested as a novel strategy. Doctor-patient communication strategies, such as expressing empathy (i.e. reassurance of nonabandonment) and explaining psychological mechanisms behind side-effects (i.e. a nocebo explanation), are most promising for optimizing patients’ expectations. In this experimental video-vignette study, we aimed to determine (1) whether clinician-expressed empathy and/or a nocebo explanation is effective in reducing expected side-effect burden, (2) whether generalized pessimism and trait anxiety relate to expected side-effect burden, and (3) whether there is an interaction between the effectiveness of these...Show moreBackground: To alleviate side-effect burden in advanced breast cancer, it is necessary to identify at-risk personality types and effective interventions. Previous research indicates that patients’ pessimism and trait anxiety may be risk factors for experiencing side-effects. To reduce their side-effect burden, optimizing patients’ side-effect expectations is suggested as a novel strategy. Doctor-patient communication strategies, such as expressing empathy (i.e. reassurance of nonabandonment) and explaining psychological mechanisms behind side-effects (i.e. a nocebo explanation), are most promising for optimizing patients’ expectations. In this experimental video-vignette study, we aimed to determine (1) whether clinician-expressed empathy and/or a nocebo explanation is effective in reducing expected side-effect burden, (2) whether generalized pessimism and trait anxiety relate to expected side-effect burden, and (3) whether there is an interaction between the effectiveness of these interventions and these personality characteristics. Methods: Using a two-by-two experimental video-vignette design, 159 cancer patients/survivors and healthy women watched one out of four videos with a nocebo explanation (present/absent) and empathy manipulation (present/absent). The effect of the interventions, the personality characteristics, and the interaction between these two were assessed using regression analyses. Differences between specific (e.g. hair loss) and nonspecific side-effects (e.g. fatigue) were investigated. Results: Clinician-expressed empathy, but not the nocebo explanation (p>.025), was successful in reducing expected side-effect occurrence (p=.008) and intensity (p=.003). Next, pessimistic patients expected side-effects to be more intense (p=.010), which was more profound in predicting the intensity of specific (p=.004), rather than nonspecific side-effects (p=.038). Moreover, results indicate an adverse effect of the nocebo explanation for pessimistic patients, as they expected nonspecific side-effects to be more intense after receiving this intervention (p=.014). Anxious patients expected a higher occurrence of nonspecific side-effects (p=.024), but not of specific side-effects (p=.435). No moderating role was found regarding patients’ anxiety and the effectiveness of the interventions. Conclusions: Short expressions of empathy by an oncologist can improve side-effect expectations. Generalized pessimism may cause patients to be vulnerable to expecting more intense side-effects, and to experiencing adverse effects from the nocebo explanation. Clinical follow-up studies need to investigate whether these results hold in clinical practice, and identify interventions for pessimistic cancer patients.Show less

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At-risk personality types in advanced cancer care: Does pessimism and trait anxiety predict patients’ chemotherapy side-effect expectations and do patients benefit from empathy or nocebo information? Findings from a scripted video-vignette RCT.